AG Healey to MassHealth providers: No charging out of pocket for gender-affirming surgeries

BOSTON – The AG’s Office is reminding MassHealth providers that most aspects of gender-affirming surgeries are covered by MassHealth and patients should not be billed out-of-pocket for any portion of covered surgeries.

“We want to raise awareness among both MassHealth patients, especially those from the transgender community, and health care providers that patients cannot be required to pay out of pocket for medical care that is covered by MassHealth, including gender-affirming surgeries,” said AG Healey. “We hope that by bringing attention to this matter, these surgeries become more accessible and affordable to those who need them, and we commend Harvard Medical Faculty Physicians for their commitment to that goal.”

In an agreement with the AG Office’s, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Inc. HMFP will reimburse MassHealth patients who were mistakenly charged directly for the chest contouring portion of their gender-affirming surgeries. HMFP will continue to provide this service to MassHealth patients, with full coverage by MassHealth.

“As a physician group providing the largest gender-affirming surgical service in New England, our commitment to compassionately and equitably serving the health care needs of the transgender community is deep and long standing,” said HMFP in a statement. “Working collaboratively with the Massachusetts Attorney General’s office, HMFP successfully achieved our shared goal to clarify coverage of this vital service to ensure coverage for eligible MassHealth patients.”

The AG’s Office reminds health care providers that MassHealth patients cannot be charged out-of-pocket payments for most aspects of gender-affirming surgeries, including the chest contouring portion of female-to-male “top” surgeries meant to treat their gender dysphoria.

The HMFP matter was handled by Assistant Attorney General Christina Chan and Investigator Katie Suttmeier of the AG’s Medicaid Fraud Division, with significant assistance from MassHealth.

The AG’s Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.